Introduction to Medicare Contractors

Medicare Administrative Contractors (MACs) are responsible for processing claims, managing policy and payment, and establishing regional policy guidelines. Are you aware that the Centers for Medicare & Medicaid Services (CMS) also uses several additional contractors to manage Medicare? CMS uses review contractors, such as the recovery audit contractor (RAC), Comprehensive Error Rate Testing (CERT) and Supplemental Medical Review Contractor (SMRC) Contractors, to conduct medical review of claims and documentation. These contractors promote the integrity of the Medicare program through audits and policy reviews, as well as the identification and monitoring of program vulnerabilities. CMS also uses several functional contractors, such as the Benefits Coordination & Recovery Center (BCRC) and zone program integrity contractors (ZPICs), who perform specific functions and are critical to ensuring the integrity of Medicare programs. Join this session to learn more about the various CMS Medicare contractors including who they are, what they do, and where to find additional information.